Biochemical and Biophysical Investigation of Surfactant in Neonatal Gastric Aspirate at Birth

Abstract

Background: The optimal approach to detection of surfactant deficiency in the prematurely born infants at birth remains unclear and the decision to apply exogenous surfactant is based mainly on the development of clinical and radiological signs of neonatal respiratory distress syndrome (NRDS). Objectives: We studied the biochemical and biophysical properties of gastric aspirates (GA) from prematurely born infants with NRDS and healthy full term infants with an aim to find an approachable method for assessment of surfactant maturity at birth. Material and Methods: Forty-seven newborn infants divided into two groups were enrolled in the study. The first group comprised 34 healthy infants born at term (after 37 weeks of gestation). The second group included 13 premature infants (aged from 26 to 32 weeks of gestation) developing clinical signs of NRDS for which they were treated by assisted ventilation and exogenous surfactant. A biochemical analysis of the protein and lipid content of GA collected at birth was performed. The fatty acid composition of the GA samples was determined by Gas Chromatography-Mass Selective Detector (GS-MSD) analysis. The surface characteristics (equilibrium, maximal and minimal surface tension values) of the GA samples were measured by using the pending drop method. Data were compared between the groups by using Student’s t test or Mann-Whitney analysis. Values were considered significantly different if the p value was ≤ 0.05. Results: The mean phospholipids’ concentration in GA of the premature infants was lower (295.7 μg / ml vs. 374.5 μg / ml) than in the term infants and the mean protein content was less in GA of the premature babies than the term newborns (574.5 μg / ml vs. 641.5 μg / ml). The measurement of dynamic surface characteristics of GA showed significantly higher mean values of the minimal surface tension (γmin) in the premature infants – 20.5 m / Nm compared to the term babies - 12.3 mN/m (p < 0,01). There was no difference between the equilibrium surface tensions (38 mN/m vs. 38 mN/m) of both groups; The mean values of maximal surface tension (γmax) in GA did not differ significantly between the groups (50.1 mN/m vs. 48.5 mN/m). Conclusion: Our findings revealed lower phospholipids’ and protein concentrations in the GA at birth from premature infants as compared to the healthy term infants. The dynamic surface characteristics of GA had significant differences between the two groups, the minimal surface tension being the most important parameter for evaluation of surfactant maturity. It could be used in the clinical practice for fast surfactant’s assessment in the premature infants in regard to administration of exogenous surfactant.